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Holistic Health Specialist

2 months ago

Richardson, Texas, United States Health Care Service Corporation Full time
Job Summary

This position plays a critical role in managing the healthcare needs of our members. As a Holistic Health Specialist, you will serve as a single point of contact for members, healthcare providers, and other stakeholders involved in managing care.

You will identify alternative treatment programs, consult with physicians, providers, and members to evaluate options and services required to meet individual health needs. Your goal will be to promote quality and cost-effective outcomes, while serving as a liaison to physicians and members.

Key Responsibilities
  • Determine member assignment of treatment and provide pre-admission/post-discharge counseling for acute conditions.
  • Establish relationships with members and provide education/local resource information to encourage member self-education.
  • Function in a clinical care advisory role, assessing members for wellness education and disease management, introducing members to our website tools, and educating members regarding wellness and specific conditions.
  • Facilitate the coordination of care for identified members and provide oversight to holistic health coordinators.
Requirements
  • Registered Nurse (RN) with current, valid, unrestricted license in the state of operations.
  • 2 years of clinical practice experience in direct clinical care to the customer.
  • 1 year of experience in care management/condition management in a health insurance/managed care setting.
  • PC proficiency to include Word, Excel, Lotus Notes, and database experience.
  • Clear and concise verbal and written communication skills.
  • Familiarity with ancillary services, including HHC, SNF, Hospice, etc.
  • Analytical skills and decision-making skills with sound clinical judgment to provide oversight of other staff.
Preferred Requirements
  • Case Management experience.
  • Experience in managing complex or catastrophic health cases.
  • Specialty clinical experience in intensive care medicine, orthopedic, NICU/pediatric, oncology, diabetic member management, obstetric (low to high risk maternity management).
  • Working toward or completion of CCM/CCP/CDE/MCG certification or Advanced degree.
  • Knowledge of Milliman Guidelines or similar clinical guidelines.
  • Knowledge of medical management policies and procedures.
Work Schedule

Monday - Friday, 9:30 AM - 6:00 PM.

HCSC Employment Statement

We are an Equal Opportunity Employment/Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.